Innovative ‘cut suit’ brings life to trauma simulations

Actual blades, needles used to treat role player wearing Hollywood-like special effects suit for training on life-saving emergency procedures
August 28th, 2019
Health professionals participate in a training simulation involving a cut suit.
A cut suit is used in a UCHealth northern Colorado region trauma training including, from left, nurse Jessica Langusch, Dr. Amy Reppert, nursing clinical educator Nathan Hammer and nurse Kathryn Cohen. Photo by Carrie Dreith, coordinator with the simulation lab.

The sudden horror of a car crash, explosion or shooting can leave a severely-injured person frightened and disoriented. To save the patient’s life, first-responders must act quickly, with care and precision.

A new tool to prepare for that moment was recently added to UCHealth training simulations in northern Colorado, with the intent of bringing a deeper sense of realism to the scenarios. The roughly 20-pound cut suit, also used in military training exercises, combines Hollywood-like special effects with a human role player.

Actual needles and blades are used. Tracheostomy and chest tubes are inserted. And blood squirts until a tourniquet has been properly applied – all on a suit worn by a person.

“You’ve got this patient who’s awake, he’s screaming, he’s agitated, he’s anxious – he’s potentially borderline combative,” said David Steiner, simulation program coordinator with UCHealth’s Clinical Education and Innovation Center at Marina Health Campus in Windsor. “You have to apply all those things you’ve been learning.”

High-tech mannequins used widely in medical training can simulate breathing or heartbeats. They can even give birth, blink and talk. But they can’t squirm or resist like a human. They also don’t bleed when cut.

“The thing I hear all the time, ‘It was weird. It was a plastic mannequin. It felt fake,'” Steiner said. “‘You’re asking me to talk to a mannequin. It’s just not the same.’

“With the cut suit, I get, ‘Wow, that was a whole other ballgame.'”

How it works for trauma training

The suit’s largest part is a chest cavity, complete with ribs, muscles, a sternum and blood bladders. The role player wears it like a vest. A silicone, skin-toned body suit is worn over the chest cavity and torso, with a separate part for the neck that includes a shield to prevent blades from stabbing through.

Among other parts are a pair of blast trousers and a blast mask, both of which simulate injuries from an explosion. There’s also a blood-pumping system, synthetic arterial wounds and a large jug of fake blood.

The patented suit, called a Tactical Combat Casualty Care (TCCC/EMS) Cut Suit, is made by San Diego-based Strategic Operations, a company that also hosts military training exercises with realistic environments including explosions, props and role players.

A silicone blood bladder is displayed in front of a cut suit chest cavity which makes trauma training more realistic..
Carrie Dreith, coordinator with the UCHealth simulation lab at the Clinical Education and Innovation Center at Marina Health Campus in Windsor, displays a repairable, silicone blood bladder that was previously cut during a cut-suit trauma training simulation. Photo by Robert Allen.

UCHealth’s cut suit training exercises are set up in outdoor, simulated emergency scenes as well as in hospitals. Steiner, a nurse with 14 years of experience, collaborates with unit educators to create realistic scenarios. He worked about five years on LifeLine, UCHealth’s critical-care, helicopter transport service. He’s also worked in the Cardiac Intensive Care Unit at Medical Center of the Rockies in Loveland and was a U.S. Air Force flight nurse.

The cut suit was obtained through a grant from the COPIC Medical Foundation, with plans to research the feasibility of the suit’s use in the hospital system.

“Results and feedback have been extremely positive so far,” Steiner said.

Every cut into the silicone parts must be repaired before it can be used again. Steiner said it’s held up well, and the parts seem “pretty durable.”

Obtained last winter, the suit has been used for training simulations at UCHealth Poudre Valley Hospital in Fort Collins and UCHealth Longs Peak Hospital in Longmont, as well as at an EMS conference in Fort Morgan, among others.

Nurses, EMS, LifeLine units and physicians have trained on it.

‘Willing suspension of disbelief’

Cut suit training scenarios are designed to create a level of stress and immediacy similar to a real-life trauma scene. Carrie Dreith, coordinator with the simulation lab, wore the cut suit during an exercise at Poudre Valley Hospital, simulating a gunshot victim who had a deflated lung and serious mouth injury.

A team of health professionals responded to the situation like it would during an actual emergency.

“They’re actually seeing it,” Dreith said. “They’re actually hearing it. They’re actually getting their pulse rate up.”

At one point, someone yelled, “hot sharp,” so Dreith was ready for what came next: “You’re watching this real knife come at you,” she said.

The suit includes multiple shields to prevent sharp objects from cutting the role player. Training participants are briefed in advance on equipment safety, and each role player has an assistant to make sure they’re OK.

The interactive suit, actor, moulage makeup and simulated severe injuries combine to create a “willing suspension of disbelief,” said Kit Lavell, executive vice president of Strategic Operations. “If it’s not there, emotions don’t get into it… (People) say it’s kind of hokey.”

A large jug of fake blood and a blast mask, worn to simulate an explosion-related injury, are among cut suit parts.
A large jug of fake blood and a blast mask are among equipment used to train UCHealth professionals during trauma training. Photo by Robert Allen.

The company’s origins are in movies and TV. President Stu Segall produced primetime TV series such as “Veronica Mars,” “Silk Stalkings” and “Renegade,” according to the company website. He created Strategic Operations in 2002 “with a mission to provide ‘Hyper-Realistic’ training for the military, law enforcement and other organizations responsible for homeland security and public safety.”

Lavell, whose experience includes 243 combat missions as a U.S. Navy pilot in Vietnam, said they’ve trained nearly 1 million people, including troops from several branches of the military, federal agencies and police. What started with tactical training scenarios in movie-like settings led to deeper development of medical elements.

“We started making blood-pumping systems. Tourniquets. Wounds,” he said. “Most of our training is medical training now.”

The TCCC/EMS Cut Suit was developed to treat the most preventable causes of death on a battlefield, which involve controlling blood loss and managing airways. A separate, more complex surgical version of the suit has also been created to simulate solid organs and a vascular system.

The suits have been included in dozens of peer-reviewed articles and military publications. Lavell said hundreds of cut suits are now in use, from Colorado to Kansas, New York, China, Australia, Europe and beyond.

“I feel very good saying that we’re saving lives,” Lavell said.